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Larcher R, Barrigah-Benissan K, Ory J, Simon C, Beregi JP, Lavigne JP, Sotto A. Peripherally Inserted Central Venous Catheter (PICC) Related Bloodstream Infection in Cancer Patients Treated with Chemotherapy Compared with Noncancer Patients: A Propensity-Score-Matched Analysis. Cancers (Basel) 2023; 15:3253. [PMID: 37370862 DOI: 10.3390/cancers15123253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
The use of peripherally inserted central catheters (PICCs) has increased in cancer patients. This study aimed to compare the incidence of PICC-related bloodstream infections (PICCR-BSIs) in cancer patients treated with chemotherapy and in noncancer patients. We performed a secondary analysis from a retrospective, single-center, observational cohort. The PICCR-BSI incidence rates in cancer and noncancer patients were compared after 1:1 propensity-score matching. Then, the factors associated with PICCR-BSI were assessed in a Cox model. Among the 721 PICCs (627 patients) included in the analysis, 240 were placed in cancer patients for chemotherapy and 481 in noncancer patients. After propensity-score matching, the PICCR-BSI incidence rate was 2.6 per 1000 catheter days in cancer patients and 1.0 per 1000 catheter days in noncancer patients (p < 0.05). However, after adjusting for variables resulting in an imbalance between groups after propensity-score matching, only the number of PICC lumens was independently associated with PICCR-BSI (adjusted hazard ratio 1.81, 95% confidence interval: 1.01-3.22; p = 0.04). In conclusion, the incidence rate of PICCR-BSI is higher in cancer patients treated with chemotherapy than in noncancer patients, but our results also highlight the importance of limiting the number of PICC lumens in such patients.
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Affiliation(s)
- Romaric Larcher
- PhyMedExp (Physiology and Experimental Medicine), INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, 34000 Montpellier, France
- Infectious and Tropical Diseases Department, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Koko Barrigah-Benissan
- VBIC (Bacterial Virulence and Chronic Infections), INSERM U1047, University of Montpellier, 34000 Montpellier, France
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Jerome Ory
- VBIC (Bacterial Virulence and Chronic Infections), INSERM U1047, University of Montpellier, 34000 Montpellier, France
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Claire Simon
- Department of Pharmacy, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Jean-Philippe Lavigne
- VBIC (Bacterial Virulence and Chronic Infections), INSERM U1047, University of Montpellier, 34000 Montpellier, France
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Albert Sotto
- Infectious and Tropical Diseases Department, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
- VBIC (Bacterial Virulence and Chronic Infections), INSERM U1047, University of Montpellier, 34000 Montpellier, France
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Barrigah-Benissan K, Ory J, Simon C, Loubet P, Martin A, Beregi JP, Lavigne JP, Sotto A, Larcher R. Clinical factors associated with peripherally inserted central catheters (PICC) related bloodstream infections: a single centre retrospective cohort. Antimicrob Resist Infect Control 2023; 12:5. [PMID: 36717942 PMCID: PMC9885663 DOI: 10.1186/s13756-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Despite their spread in daily practice, few data is available on clinical factors associated with peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI). We aimed to assess the PR-BSI incidence, microbiology, and factors associated with PR-BSI with a focus on clinical symptoms. METHODS We conducted a retrospective cohort study in a French university hospital. We screened all PICC insertions performed from April 1st, 2018, to April 1st, 2019, and included PICC insertions in adult patients. We assessed the PR-BSI incidence, the factors associated with PR-BSI using a Cox model, and negative and positive predictive values (NPVs and PPVs) of each clinical sign for PR-BSI. RESULTS Of the 901 PICCs inserted in 783 patients (38,320 catheters days), 214 PICCs (24%) presented with a complication. The most prevalent complication was PR-BSI (1.9 per 1000 catheter days; 8.1% of inserted PICCs ). Enterobacterales (N = 27, 37%) and coagulase negative Staphylococci (N = 24, 33%), were the main microorganisms responsible for PR-BSI. Factors independently associated with occurrence of PR-BSI were fever (hazard ratio 13.21, 95% confidence interval 6.00-29.11, p < 0.001) and chills (HR 3.66, 95%CI 1.92-6.99, p < 0.001). All clinical signs and a duration of PICC maintenance ≥ 28 days, had a low PPVs (≤ 67.1%) but high NPVs (≥ 92.5%) for PR-BSI. CONCLUSIONS Monitoring of clinical signs, especially fever and chills, with caution and limitation of device maintenance duration, could improve PICC management.
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Affiliation(s)
- Koko Barrigah-Benissan
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Jerome Ory
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Claire Simon
- grid.411165.60000 0004 0593 8241Department of Pharmacy, CHU Nimes, Nimes, France
| | - Paul Loubet
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Aurelie Martin
- grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Jean-Paul Beregi
- grid.411165.60000 0004 0593 8241Department of Medical Imaging, CHU Nimes, Nimes, France
| | - Jean-Philippe Lavigne
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Albert Sotto
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Romaric Larcher
- Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000, Nimes, France. .,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France.
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Barrigah-Benissan K, Ory J, Boudet A, Stephan R, Sotto A, Lavigne JP. Environmental detection of SARS-CoV-2 in hospital rooms in different wards of an University Hospital. J Hosp Infect 2022; 128:74-79. [PMID: 35944790 PMCID: PMC9356633 DOI: 10.1016/j.jhin.2022.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/21/2022] [Accepted: 07/05/2022] [Indexed: 11/20/2022]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- K Barrigah-Benissan
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, Nîmes, France
| | - J Ory
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, Nîmes, France.
| | - A Boudet
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, Nîmes, France
| | - R Stephan
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, Nîmes, France
| | - A Sotto
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Infectious and Tropical Diseases, University of Montpellier, CHU Nîmes, Nîmes, France
| | - J-P Lavigne
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, Nîmes, France
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Barrigah-Benissan K, Ory J, Sotto A, Salipante F, Lavigne JP, Loubet P. Antiseptic Agents for Chronic Wounds: A Systematic Review. Antibiotics (Basel) 2022; 11:antibiotics11030350. [PMID: 35326813 PMCID: PMC8944418 DOI: 10.3390/antibiotics11030350] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/01/2023] Open
Abstract
In many parts of the world, antiseptic agents remain non-indicated in chronic wound care. In the current context of bacterial resistance to antibiotics and the development of new-generation antiseptic agents, wound antisepsis represents an asset for the prevention of wound infection. We aimed to evaluate four common antiseptic agents in chronic wound care complete healing. The review protocol was based on the Cochrane Handbook for Systematic Reviews of Intervention and devised in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement guidelines. Five databases and three clinical trials registries were searched from inception to 30 June 2021 without language restrictions. We included randomised trials evaluating the efficacy of antiseptic agents in chronic wound care in adults. Interventions considered were those using antiseptics for cleansing or within a dressing. Risk of bias was assessed using the bias excel tool provided by the Bristol Academy. Evidence quality was assessed using Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria. Of 838 studies, 6 were finally included, with a total of 725 patients. The included studies assessed iodine (cadexomer or povidone iodine) (n = 3), polyhexanide (n = 2), and octenidine (n = 1). Limited evidence suggested a better wound healing completion with iodine compared to saline (two randomised controlled trials (RCT), 195 patients, pooled RR 1.85 (95%CI (1.27 to 2.69)), moderate-quality evidence). There was not enough evidence to suggest a difference in wound healing using octenidine or polyhexamide. None of the antiseptic agents influenced adverse event occurrence compared to saline.
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Affiliation(s)
- Koko Barrigah-Benissan
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (K.B.-B.); (J.O.)
| | - Jérôme Ory
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (K.B.-B.); (J.O.)
| | - Albert Sotto
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Infectious Diseases, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (A.S.); (P.L.)
| | - Florian Salipante
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, University of Montpellier, CHU Nîmes, 30029 Nîmes, France;
| | - Jean-Philippe Lavigne
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (K.B.-B.); (J.O.)
- Correspondence: ; Tel.: +33-466683202
| | - Paul Loubet
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Infectious Diseases, University of Montpellier, CHU Nîmes, 30029 Nîmes, France; (A.S.); (P.L.)
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